Predictive value of cervical length in placenta previa totalis: a single-center experience

Year 2024, Volume: 7 Issue: 1, 68 - 72, 15.01.2024

Özge Kahramanoğlu Aydın Öcal

https://doi.org/10.32322/jhsm.1360800

Abstract

Aims: In our study, we aimed to scientifically assess the utility of measuring cervical length in predicting the risk of postpartum hemorrhage and the necessity for emergency preterm cesarean delivery in women diagnosed with placenta previa totalis.
Methods: We conducted a retrospective study at a single medical center, comprising 48 pregnant women diagnosed with placenta previa totalis. Cervical length was precisely measured through transvaginal ultrasound. Patients were categorized based on cervical length (CL): CL >30mm, CL 25-30 mm, and CL <25 mm. Primary outcomes included preterm birth, postpartum hemorrhage, and emergency cesarean section.
Results: Women with CL <25 mm exhibited a notably elevated risk of postpartum hemorrhage (60%) and emergency cesarean section (80%). While preterm birth rates displayed variations among groups, statistical significance remained elusive. APGAR scores demonstrated consistency across cervical length categories.
Conclusion: Evaluation of cervical length holds promise as a valuable tool in the comprehensive management of placenta previa totalis. Women presenting with a cervical length less than 25 mm may warrant intensified monitoring and targeted interventions to mitigate adverse perinatal outcomes. Further research endeavors are imperative to corroborate these findings and advance the care provided for these intricate pregnancies.

Keywords

Placenta previa, hemorrhage, preterm birth, ultrasonography

Ethical Statement

The study received ethical approval from the Ethics Committee of the University of Health Science, Istanbul Haseki Training and Research Hospital (Approval number: 20.09.2023-162-2023).

References

• Fan D, Wu S, Liu L, et al. Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis. Scientific Reports. 2017;7(1):40320.
• Shin JE, Shin JC, Lee Y, Kim SJ. Serial change in cervical length for the prediction of emergency cesarean section in placenta previa. PLoS One. 2016;11(2):e0149036.
• Hasegawa J, Higashi M, Takahashi S, et al. Can ultrasonography of the placenta previa predict antenatal bleeding?. J Clin Ultrasound. 2011;39(8):458-462. doi:10.1002/jcu.20849
• Cresswell JA, Ronsmans C, Calvert C, Filippi V. Prevalence of placenta praevia by world region: a systematic review and meta‐analysis. Tropic Med Int Health. 2013;18(6):712-724.
• Cunningham FG, Leveno KL, Bloom SL, et al. Obstetrical hemorrhage. In: Cunningham FG, Leveno KL, Bloom SL, et al. eds. Williams Obstetrics, 23rd ed. New York: McGraw-Hill; 2010, chap 35.
• Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol. 2006;107(4):771-778.
• Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet Gynecol. 2002;99(6):976-980.
• Iams JD, Goldenberg RL, Meis PJ, et al. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med. 1996;334(9):567-573.
• Lim AC, Hegeman MA, Huis In ‘T Veld M, Opmeer B, Bruinse H, Mol B. Cervical length measurement for the prediction of preterm birth in multiple pregnancies: a systematic review and bivariate meta‐analysis. Ultrasound Obstet Gynecol. 2011;38(1):10-17.
• Sekiguchi A, Nakai A, Okuda N, Inde Y, Takeshita T. Consecutive cervical length measurements as a predictor of preterm cesarean section in complete placenta previa. J Clin Ultrasound. 2015;43(1):17-22. doi:10.1002/jcu.22205
• Fukushima K, Fujiwara A, Anami A, et al. Cervical length predicts placental adherence and massive hemorrhage in placenta previa. J Obstet Gynaecol Res. 2012;38(1):192-197. doi:10.1111/j.1447-0756.2011.01669.x
• Altraigey A, Ellaithy M, Barakat E, Majeed A. Cervical length should be measured for women with placenta previa: cohort study. J Matern Fetal Neonatal Med. 2021;34(13):2124-2131. doi: 10.1080/14767058.2019.1659239
• Taipale P, Hiilesmaa V. Sonographic measurement of uterine cervix at 18–22 weeks’ gestation and the risk of preterm delivery. Obstet Gynecol. 1998;92(6):902-907.
• Ghi T, Contro E, Martina T, et al. Cervical length and risk of antepartum bleeding in women with complete placenta previa. Ultrasound Obstet Gynecol. 2009;33(2):209-212.
• Obstetricians ACo, Gynecologists. Prediction and prevention of spontaneous preterm birth: ACOG Practice Bulletin, Number 234. Obstetr Gynecol. 2021;138(2):e65-e90.
• Mimura T, Hasegawa J, Nakamura M, et al. Correlation between the cervical length and the amount of bleeding during cesarean section in placenta previa. J Obstet Gynaecol Res. 2011;37(7):830-835. doi:10.1111/j.1447-0756.2010.01446.x
• Hessami K, Mitts M, Zargarzadeh N, Jamali M, Berghella V, Shamshirsaz AA. Ultrasonographic cervical length assessment in pregnancies with placenta previa and risk of perinatal adverse outcomes: A systematic review and meta-analysis. Am J Obstet Gynecol MFM. doi:10.1016/j.ajogmf.2023.101172
• Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. Critical analysis of risk factors and outcome of placenta previa. Archives Gynecol Obstet. 2011;284:47-51.
• Zaitoun MM, El Behery MM, Abd El Hameed AA, Soliman BS. Does cervical length and the lower placental edge thickness measurement correlates with clinical outcome in cases of complete placenta previa? Archives Gynecol Obstet. 2011;284:867-873.
• Stafford IA, Dashe JS, Shivvers SA, Alexander JM, McIntire DD, Leveno KJ. Ultrasonographic cervical length and risk of hemorrhage in pregnancies with placenta previa. Obstet Gynecol. 2010;116(3):595-600.